Anterior cruciate ligament graft fixation first in anterior and posterior cruciate ligament reconstruction best restores knee kinematics

作者:Zheng Libin; Sabzevari Soheil; Marshall Brandon; Zhu Junjun; Linde Monica A; Smolinski Patrick; Fu Freddie H*
来源:Knee Surgery, Sports Traumatology, Arthroscopy, 2018, 26(4): 1237-1244.
DOI:10.1007/s00167-017-4615-6

摘要

To evaluate the effect of different graft fixation sequences in one-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction on (1) knee biomechanics and (2) tibiofemoral alignment.
Twelve porcine knees were used in this study. Five fixation sequences were performed (angle indicating knee flexion): (a) PCL at 30A degrees and ACL at 30A degrees, (b) PCL at 90A degrees and ACL at 30A degrees, (c) ACL at 30A degrees and PCL at 30A degrees, (d) ACL at 30A degrees and PCL at 90A degrees, and (e) ACL and PCL simultaneous fixation at 30A degrees. Anterior and posterior tibial translation was measured under an 89 N load. A 3-D digitizer was used to measure the change in anteroposterior (AP) tibiofemoral position.
None of the graft fixation sequences restored the AP laxity of the intact knee, and there are minimal differences in the in situ tissue forces in the ACL and PCL grafts. The reconstructions with fixation of the PCL graft first resulted in a significantly larger change in AP tibiofemoral position from the intact knee at 60A degrees and 90A degrees of knee flexion than the reconstructions with fixation of the ACL graft first (p < 0.05).
Fixation of the ACL graft at 30A degrees of knee flexion followed by fixation of the PCL graft can best restore the tibiofemoral position of the intact knee. This study has clinical relevance in regard to the effect of graft fixation sequence on the position of the tibia relative to the femur in one-stage ACL and PCL reconstruction.

  • 出版日期2018-4